Is the legal challenge to Obamacare finally over?

The Supreme Court by 6-3 vote upheld Obamacare subsidies by ruling against a challenge contending only state’s could set up insurance exchanges.

Doctors, Democratic politicians and lawyers said the U.S. Supreme Court upholding the Affordable Care Act should finally put to rest any legal challenges to Obamacare and said it is now up to Congress to amend the law and for states to make it work for them, rather than fight it.

Ruling 6-3 in King vs. Burwell, the Supreme Court upheld the nationwide tax subsidies that are the foundation to President Barack Obama’s health care overhaul. It rejected a challenged based on semantics that threatened the health insurance for more than 1 million Floridians who receive Obamacare through the federal exchange.

“Things have to go through Congress not the Supreme Court,” said Dr. Alan Pillersdorf, the president of the Florida Medical Association. “If they want to change the Affordable Care Act, that is the mechanism.”

U.S. Rep. Ted Deutch, D-Fla, twitted: “It is time for Republicans to recognize that this law is here to stay.”

But Republicans opposing Obamacare weren’t conceding any ground Thursday with many of the frontrunners for the GOP presidential bid vowing to continue the fight to repeal the 900-page law. U.S. Sen. Marco Rubio, the presidential candidate from Florida, said he disagreed with the Supreme Court that the challenge amounted to a drafting error by Congress.

“Obamacare is still a bad law that is having a negative impact on our country and on millions of Americans,” the Miami Republican said in statement. “I remain committed to repealing this bad law and replacing it with my consumer-centered plan that puts patients and families back in control of their health care decisions.”

At issue in King v. Burwell is that the law dictates “the state” will set up health care exchanges. When states controlled by Republican lawmakers balked, the federal government stepped in and set up its own exchange.

About 87 percent of individuals who enrolled through the federal website are receiving subsidies in 34 states whose legislatures have not set up their own exchanges. Advocates estimated about about 6.4 million people could have lost their subsidies if the High Court ruled in favor of King.

Chief John Roberts, who had authored the landmark opinion upholding the law in 2012, again spoke for the majority. He said the limiting subsidies to individuals only in states with their own exchanges could well push insurance markets in the other states “into a death spiral,” Roberts wrote

If the Supreme Court ruled in favor of the plaintiffs, health insurance costs were expected to triple for 1.3 million Floridians, advocacy groups warned.

Through using the exchange healthcare.gov, the average monthly premium in the state is $82. Without the exchange, that premium skyrockets to $376, advocacy group Families USA figures.

Dr. Ronald Wiewora, the CEO of the Health Care District of Palm Beach County, called it “a good news day.”

He said the district, which helps uninsured residents in the county with health care coverage, was preparing to phase out at the end of the year its own subsidy program called Vita Health. King v. Burwell case, though, was giving Wiewora pause.

He noted that King V. Burwell hardly fixes the problems left by Florida refusing to accept federal Medicaid expansion money to set up its own exchange.

Expecting Obamacare to ease the burden on hospitals providing care to the indigent through the state setting up exchanges, the federal government is expected to phase out the $1 billion low income pool, also known as LIP. Wiewora said the district expects to take a $3 million hair cut and is looking at cost-cutting measures.

There are also an estimated 650,000 Floridians who remain in the what is called the coverage gap — unable to pay for insurance and unable to qualify for the Affordable Care Act. This is attributed again to Florida being one of the states refusing to accept Medicaid expansion money to set up its own exchange.

Scott and House leadership rejected a plan put forth by the Senate this year to extend health care coverage to those individuals.

“We providers are all about people having access to care and Obamacare has been a way people have been able to get that acess and to get that coverage,” Wiewora said. “We are very please where it went today.”

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